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In 2004, cosmetic surgeons performed more than 150,000 abdominoplasties (commonly known as the "tummy tuck"), according to the American Society for Aesthetic Plastic Surgery. Abdominoplasty is a major surgical procedure in which surgeons remove excess skin and fat from the middle and lower abdomen and tighten abdominal muscles. The procedure can dramatically flatten a protruding abdomen.
The surgery can be performed either in an outpatient surgical center or in a hospital. Depending on the case, a two- or three-day stay in the hospital may be required. A mini tummy tuck could even be done as an outpatient procedure. General anesthesia (or, for minimal work, local) combined with a sedative may be used. The surgery lasts two to five hours, depending on the work required. The surgeon will usually make a long incision from hip bone to hip bone, just above the pubic area. A second incision is made to remove the navel from surrounding tissue. The surgeon separates and lifts the skin from the abdominal wall all the way up to the ribs. These vertical muscles are tightened by pulling and stitching them together. This produces a firmer abdominal wall and narrower waistline. The doctor then stretches the skin flap downward and extra skin is removed. A new hole is cut for the navel, which is stitched in place. The larger incision is stitched in place, and a temporary tube may be inserted to drain excess fluid.
Abdominoplasty can be combined with liposuction to remove fat deposits from the hips to create a more satisfying contour. In some cases, liposuction alone may produce the best results.
If fat deposits are limited to the area below the navel, you may be a candidate for a partial abdominoplasty (or "mini tummy tuck"), which can be performed on an outpatient basis. During this procedure, which lasts an hour or two, the skin is separated only between the incision site and the navel. The skin flap is stretched down, the excess is removed, and the flap is sutured in place.
Pain Level/Recovery Time: For the first few days, patients usually experience swelling and discomfort. Pain may be controlled with medication. You will receive instructions about showering and changing your dressings. Though standing may be difficult at first, you should start walking as soon as possible. Surface stitches or staples will be removed within a week, while deeper stitches simply get absorbed.
Recovery may take weeks or months. If you start out in good shape with strong abdominal muscles, healing will be much faster. Some people can return to work after two weeks, while others take three or four weeks to return to their usual routine. Mild to moderate exercise helps reduce swelling, lowers the chances of blood clots, and tones muscles. Vigorous exercise should be avoided until the patient feels she can do it comfortably.
Patients are usually left with a permanent scar that can extend from hip to hip, usually in an area hidden by underwear or bikinis. The scar may appear to worsen during the first three to six months, but this is a normal part of healing. It may take from nine months to a year for the scar to flatten out and fade in color. With diet and exercise, the positive results of abdominoplasty may last for years.
$4,917 (national average for surgeon's fees)** Average surgeon's fee for abdominoplasty may vary by region:
For New England (CT, ME, MA, NH, RI, VT) and Middle Atlantic (NJ, NY, PA): $5,408 For North East Central (IL, IN, MI, OH, WI) and North West Central (IA, KS, MN, MO, NE, ND, SD): $4,524 For South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV): $4,672 For East South Central (AL, KY, MS, TN) and West South Central: (AR, LA, OK, TX): $4,144 For Mountain (AZ, CO, ID, MT, NV, NM, UT, WY) and Pacific (AK, CA, HI, OR, WA): $5,212
** Note: These averages for surgeon's fees are provided by the American Association for Aesthetic Plastic Surgery, Inc. These figures do not include fees for the surgical facility, anesthesia, medical tests, prescriptions, or other miscellaneous costs related to surgery. In most cases, health insurance will not cover the cost of abdominoplasty, but you should check to be sure.
The best candidates for a tummy tuck are individuals who are in relatively good shape, but are troubled by excess fat, loose skin, or protruding muscles that will not respond to diet or exercise. Ninety-six percent of tummy tucks are performed on women, particularly those whose abdominal muscles and skin are permanently stretched from multiple pregnancies. Patients planning to lose a significant amount of weight or planning future pregnancies should wait. Muscles that are tightened during the surgery may separate during pregnancy. In addition, doctors may recommend against abdominoplasty if you have scars from previous abdominal surgery.
Post-operative complications include the following: Infection (which can be treated with drainage and antibiotics); blood clots (which can be minimized by moving around soon after surgery); and poor healing (which can result in a noticeable scar and may require a second operation). Smokers should quit smoking for at least two weeks before and after surgery (or permanently), since smoking can increase risks of complications and delay healing.
Linda, 47, Pittsburgh Linda, a retired lawyer, had a tummy tuck in October 2003. She has two teenaged children. "Even before I had them, I had a little bit of a gut, no matter how little or how much I weighed. I never liked it. I'd always been self-conscious about it," Linda says.
Her doctor explained that muscles in her abdomen had separated about the width of a soda can, causing her belly to protrude. "I looked like I was about six months pregnant," Linda says. No amount of diet or exercise could repair the muscles. Her doctor said that abdominoplasty was her best bet.
The surgery required general anesthesia and a one-night stay in the hospital. After two or three hours in surgery, Linda awoke in pain. "I had a smile-shaped incision from hip bone to hip bone," she says. She was able to walk the next day, but the recovery was a long haul. "They give you the standard six weeks to heal and it took every day of those six weeks," she recalls. "Abdominal surgery is very serious. It shouldn't be taken lightly." It may take 18 months for Linda's incision to heal completely.
Despite the pain and long recovery, Linda is pleased with the results. "Even though there was initial swelling, the results were almost immediate," she says. "I've gotten even flatter since I've healed." She feels confident that she'll look better in a swimsuit this summer. And her wardrobe needs an overhaul. "I sew a lot," she says. "I'm making some new clothes to fit my new shape."
To Learn More: Visit the Public Site section of the American Society for Aesthetic Plastic Surgery's Web site. Or call their toll-free referral line at 1-888-ASAPS-11.
Check out the Learn section of BeautySurg.com, the "cosmetic surgery supersite."
For physician referrals, call the American Society of Plastic Surgeons referral service at 1-888-4PLASTIC or visit them online. Click on "Learn About Procedures" to find out more.